Severe diffuse alveolar hemorrhage related to autoimmune disease: a multicenter study

被引：21

作者：

Mirouse, Adrien ^{[1
,2
,3
,4
,5
]}

Parrot, Antoine ^{[6
]}

Audigier, Vincent ^{[7
]}

Demoule, Alexandre ^{[8
]}

Mayaux, Julien ^{[8
]}

Geri, Guillaume ^{[9
]}

Mariotte, Eric ^{[10
]}

Brechot, Nicolas ^{[11
]}

de Prost, Nicolas ^{[12
]}

Vautier, Mathieu ^{[13
]}

Neuville, Mathilde ^{[14
]}

Bige, Naike ^{[15
]}

de Montmollin, Etienne ^{[16
]}

Cacoub, Patrice ^{[1
,2
,3
,4
,5
]}

Resche-Rigon, Matthieu ^{[7
]}

Cadranel, Jacques ^{[6
]}

Saadoun, David ^{[1
,2
,3
,4
,5
]}

机构：

[1] UPMC Univ Paris 06, Dept Hosp Univ Inflammat Immunopathol Biotherapie, UMR 7211, Sorbonne Univ, F-75005 Paris, France

[2] INSERM, UMR S 959, F-75013 Paris, France

[3] CNRS, FRE3632, F-75005 Paris, France

[4] Grp Hosp Pitie Salpetriere, AP HP, Dept Med Interne & Immunol Clin, Natl Ctr Autoimmune & Syst Dis, F-75013 Paris, France

[5] Grp Hosp Pitie Salpetriere, AP HP, Natl Ctr Autoinflammatory Dis & Amyloidosis, F-75013 Paris, France

[6] Hop Tenon, AP HP, Serv Pneumol, Paris, France

[7] Hop St Louis, AP HP, Dept Biostat, Paris, France

[8] Hop La Pitie Salpetriere, AP HP, Serv Reanimat Med & Pneumol, Paris, France

[9] Hop Cochin, AP HP, Serv Reanimat Med, Paris, France

[10] Hop St Louis, AP HP, Serv Reanimat Med, Paris, France

[11] Hop La Pitie Salpetriere, AP HP, Serv Reanimat Med, Paris, France

[12] Hop Henri Mondor, AP HP, Serv Reanimat Med, Crete, France

[13] CHU Caen, Serv Med Interne, Caen, France

[14] Hop Bichat Claude Bernard, AP HP, Serv Reanimat Med, Paris, France

[15] Hop St Antoine, Serv Reanimat Med, Paris, France

[16] Hop Delafontaine, Serv Reanimat Med Chirurg, St Denis, France

来源：

CRITICAL CARE | 2020年 / 24卷 / 01期

关键词：

Diffuse alveolar hemorrhage; ICU; mechanical ventilation; Plasma exchange; ANCA-associated vasculitis; Anti-MBG-associated vasculitis; IgA-associated vasculitis; Cryoglobulinemia; Systemic lupus erythematosus; Antiphospholipid syndrome; EULAR/ERA-EDTA RECOMMENDATIONS; ANTIBODY-ASSOCIATED VASCULITIS; RESPIRATORY-FAILURE; PLASMA-EXCHANGE; CLASSIFICATION CRITERIA; CYCLOPHOSPHAMIDE; VENTILATION; PREDICTORS; RITUXIMAB; MANAGEMENT;

D O I：

10.1186/s13054-020-02936-0

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

BackgroundDiffuse alveolar hemorrhage (DAH) occurs during the course of autoimmune disease and may be life threatening. The objective was to assess characteristics and prognosis factors of DAH who required intensive care unit (ICU) admission in patients with autoimmune diseases.MethodsFrench multicenter retrospective study including patients presenting DAH related to autoimmune diseases requiring ICU admission from 2000 to 2016.ResultsOne hundred four patients (54% of men) with median age of 56 [32-68] years were included with 79 (76%) systemic vasculitis and 25 (24%) connective tissue disorders. All patients received steroids, and 72 (69%), 12 (11.5%), and 57 (55%) patients had cyclophosphamide, rituximab, and plasma exchanges, respectively. During ICU stay, 52 (50%), 36 (35%), and 55 (53%) patients required mechanical ventilation, vasopressor use, and renal replacement therapy, respectively. Factors associated with mechanical ventilation weaning were age (HR [95%CI] 0.97 [0.96-0.99] per 10years, p<0.0001), vasculitis-related DAH (0.52 [0.27-0.98], p=0.04), and time from dyspnea onset to ICU admission (0.99 [0.99-1] per day, p=0.03). ICU mortality was 15%. Factors associated with alive status at ICU discharge were chronic cardiac failure (HR [95%CI] 0.37 [0.15-0.94], p=0.04), antiphospholipid syndrome-related DAH (3.17 [1.89-5.32], p<0.0001), SAPS II (0.98 [0.97-0.99], p=0.007), and oxygen flow at ICU admission (0.95 [0.91-0.99] per liter/min, p=0.04).ConclusionDAH in autoimmune diseases is a life-threatening complication which requires mechanical ventilation in half of the cases admitted to ICU.

引用

页数：10

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